Provider Demographics
NPI:1477641074
Name:NORTH WARREN MEDICAL ASSOC
Entity Type:Organization
Organization Name:NORTH WARREN MEDICAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESEDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-852-0107
Mailing Address - Street 1:PANTHER VALLEY MALL, BLDG B ROUTE 517
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840
Mailing Address - Country:US
Mailing Address - Phone:908-852-0107
Mailing Address - Fax:908-850-9160
Practice Address - Street 1:PANTHER VALLEY MALL, BLDG B ROUTE 517
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840
Practice Address - Country:US
Practice Address - Phone:908-852-0107
Practice Address - Fax:908-850-9160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8121907Medicaid
NJ8121907Medicaid